Search

Introduction: Synthetic anabolic androgenic steroids (AAS), compounds mimicking the action of endogenous testosterone in enhancing training performance, have been extensively studied during the last century. AAS abuse has become a major public health concern with an estimated worldwide lifetime prevalence of 1–5%1 . Long-term administration of AAS in supraphysiological doses may have detrimental effects on the cardiovascular system, presumably through direct action on cardiac myocyte androgen receptors. In severe cases, life-threatening conditions such as myocardial infarction, aortic dissection or cardiomyopathy, particularly dilated cardiomyopathy as the most common form, may occur. Hereby, we report a rare case of AAS-induced cardiomyopathy with an emphasis on the multidisciplinary approach. Case report: 46-year-old male bodybuilder presented with exercise intolerance unrelated to maximum training load and post-workout water retention 6 weeks before the visit. History revealed previous administration of testosterone enanthate 500 mg every 8 to 12 days during the period of 4 years. After a month-long cessation, he started taking testosterone undecanoate 1000 mg in 6-week intervals. The cardiorespiratory part of the physical examination showed normal findings and blood pressure of 125/80 mmHg. The patient was of athletic build with no signs of increased hairiness and no palpable testicular mass. An electrocardiogram showed a normal electrical axis and sinus bradycardia. Laboratory assessment (Table 1) was followed by echocardiography which was in accordance with the diagnosis of AAS-induced cardiomyopathy (Figure 1). Further diagnostic assessment of osteoporosis, hepatic, renal and psychological complications was performed. Conclusion: Long-term administration of AAS with unknown pharmacokinetic and pharmacodynamic properties should be considered as a cause of newly diagnosed cardiomyopathy, especially in previously healthy individuals with an athletic background. [ABSTRACT FROM AUTHOR]

Memory CD8 T cells play an important role in the protection against breakthrough infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Whether the route of antigen exposure impacts these cells at a functional level is incompletely characterized. Here, we compare the memory CD8 T cell response against a common SARS-CoV-2 epitope after vaccination, infection, or both. CD8 T cells demonstrate comparable functional capacity when restimulated directly ex vivo , independent of the antigenic history. However, analysis of T cell receptor usage shows that vaccination results in a narrower scope than infection alone or in combination with vaccination. Importantly, in an in vivo recall model, memory CD8 T cells from infected individuals show equal proliferation but secrete less tumor necrosis factor (TNF) compared with those from vaccinated people. This difference is negated when infected individuals have also been vaccinated. Our findings shed more light on the differences in susceptibility to re-infection after different routes of SARS-CoV-2 antigen exposure. [Display omitted] • Infection and vaccination against SARS-CoV-2 both favor CD8 T EMRA differentiation • Ex vivo functionality of memory T cells is similar after infection and vaccination • The scope of memory CD8 T cells is larger after infection than after vaccination • Vaccination-induced memory generates secondary effectors with superior functionality Kavazović et al. compare SARS-CoV-2-specific memory CD8 T cells from people after infection, vaccination, or both. Infection induces a more clonally diverse memory pool than vaccination, but these cells produce less TNF after in vivo recall. Subsequent vaccination negates differences, stressing the importance of boosting irrespective of antigenic history. [ABSTRACT FROM AUTHOR]

Background: Peripheral arterial disease (PAD) reduces functional capacity and raises cardiovascular risks, but underdiagnosis is common, resulting in less comprehensive care than other cardiovascular conditions. While diabetes has long been viewed as a key risk factor for PAD, recent studies indicate that its impact is influenced by the presence of concurrent cardiovascular risk factors. The aim of this study is to elucidate the intricate relationship between the prevalence of PAD, diabetic complications, and cardiovascular risk factors among asymptomatic patients with type 2 diabetes mellitus (T2DM)., Methods: Ninety-one patients with T2DM and no symptoms or previous diagnosis of PAD were recruited from the outpatient diabetic clinic. Clinical data were extracted from electronic medical records, and the screening for PAD was conducted using MESI mTABLET., Results: Screening for PAD among asymptomatic individuals with T2DM revealed that 5.49 % of patients exhibit a low ankle-brachial index (ABI). Patients who had previously experienced major adverse cardiovascular events or exhibited albuminuria displayed lower ABI values. Furthermore, a striking 45.05 % of the participants displayed an abnormally high carotid-femoral pulse wave velocity (cfPWV) value, with elevated PWV values correlating with advanced age and longer diabetes duration., Conclusions: The prevalence of elevated cfPWV is more pronounced than that of decreased ABI in T2DM patients with asymptomatic PAD and is associated with older age and longer diabetes duration, therefore measurement of both ABI and PWV is crucial for the cardiovascular risk assessment protocol for patients with T2DM and timely PAD diagnosis., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Chronic pain is a painful condition defined by its duration where pain persists three months or more. Pain is connected with the high price of health care, work inability and disability. Moreover, it has significant consequences for patients and their families, working organizations and the society as a whole. The prevalence of chronic pain can range between 11.0% and 51.3% in general population. Pain is usually coherent with distress and a range of psychological symptoms such as depression, anxiety, altered attention and cognition manifesting as fear. Comprehensive pain management should always include the treatment of associated psychological symptoms. Multidisciplinary approach in treating chronic pain and its comorbidities and proper education of primary care physicians and different specialists involved in the management of chronic pain are crucial for better clinical outcomes. Topical capsaicin acts as a highly selective agonist of transient receptor potential vanilloid 1 of C and Aδ nociceptors. Repeated applications or high concentrations give rise to a long-lasting effect termed defunctionalisation. In addition, the reduction of central sensitization through reduced C-nociceptor input contributes to capsaicin's indirect mechanism of action. Capsaicin provides effective durable pain relief and reduction of intensity and area of pain in adult patients with chronic pain with a faster onset of analgesia and considerably fewer systemic adverse effects than the conventional treatment. While offering high levels of pain relief, additional improvements in sleep, fatigue, depression and quality of life have been noticed. Topical administration avoids dangerous systemic adverse effects and enables the combination with other drugs and analgesics with limited drug-drug interactions. Adding capsaicin to the standard chronic pain treatment might improve, fasten and ease the challenging path of managing chronic pain consequently providing the patient and their society with better quality of life.